— This study was conducted to find out the impact of menopausal transition symptoms on quality of life and eating behavior in west Algerian women. Subjects and methods: A prospective cross sectional survey was conducted between February 22 and April 30, 2016 in Oran (west Algeria). Eighty (48±2 years) perimenopausal women participated to the study. A structured interview survey was developed on socioeconomic level, climacteric symptoms and quality of life. Daily energy expenditure (DEE) was assessed by an adapted questionnaire and food intake by a 24h "Recall and Record". Results. Hot flushes, night sweats, palpitations, anxiety, headaches, memory loss and insomnia were the symptoms feeling by women. The quality of life assessment showed that 53% had a moderate quality of life (10 to 15 symptoms), 16% with poor quality of life (16-20 symptoms) whereas 25% had a good quality of life (5 to 10 symptoms) and 6% of women had an excellent quality of life (≤ 5 symptoms). At this time of the menopausal transition, 64% reported modification in their eating behavior. Conclusion: Clinical symptoms of perimeanopausal period influence the quality life of women on menopausal transition.

1. International Multispecialty Journal of Health (IMJH) ISSN: [2395-6291] [Vol-3, Issue-3, March- 2017]
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Perimenopausal symptoms, quality of life and eating behavior
in west Algerian women
Senouci Azzeddine1§
, Chenni Jahida2
, Derriche Abdelkader3
, Zemour Lakhdar4
,
Mekki Khedidja5
1,5
Faculty of Sciences of Nature and Life, University of Oran1 Ahmed Benbella, Oran 31100, Algeria
2
Public Proximity Health Center, Boutlilis, Oran 31170, Algeria
3
Obstetrical and gynecological Medical office, Oran 31033. Algeria
4
Department of Epidemiology, University Hospital, Oran 31037, Algeria
Abstract— This study was conducted to find out the impact of menopausal transition symptoms on
quality of life and eating behavior in west Algerian women.
Subjects and methods: A prospective cross sectional survey was conducted between February 22 and
April 30, 2016 in Oran (west Algeria). Eighty (48±2 years) perimenopausal women participated to the
study. A structured interview survey was developed on socioeconomic level, climacteric symptoms and
quality of life. Daily energy expenditure (DEE) was assessed by an adapted questionnaire and food
intake by a 24h "Recall and Record".
Results. Hot flushes, night sweats, palpitations, anxiety, headaches, memory loss and insomnia were the
symptoms feeling by women. The quality of life assessment showed that 53% had a moderate quality of
life (10 to 15 symptoms), 16% with poor quality of life (16-20 symptoms) whereas 25% had a good
quality of life (5 to 10 symptoms) and 6% of women had an excellent quality of life (≤ 5 symptoms). At
this time of the menopausal transition, 64% reported modification in their eating behavior.
Conclusion: Clinical symptoms of perimeanopausal period influence the quality life of women on
menopausal transition.
Keywords: Perimenopause, Quality of life, Behavior food
I. INTRODUCTION
Peri-menopause is the tormented period that precedes menopause and is reflected by symptoms of
hyperestrogenism or hypoestrogenism, evidence of the progressive weakening of hormonal secretions.1
It spreads over 2 to 8 years preceding menopause and 1 year after the final menstruation. 2
Menopause is defined as the permanent cessation of menstruation. The age at which it occurs is between
45 and 55 years.3
Menopause is a physiological event in the women’s life. Natural menopause is
recognized after 12 months of amenorrhea that is not associated with a pathologic cause. 4
It is caused
by aging of ovaries which leads to decline in the production of ovarian estrogen and progesterone. That
occurs naturally or is induced by surgery chemotherapy or radiation. The deficiency in these hormones
elicits various somatic, vasomotor, sexual and psychological symptoms that impair the overall quality of
life of women. 5
During the menopausal transition, women undergo various physical, psychological and social changes
that can affect their quality of life. 6
Several symptoms including hot flushes, night sweats, vaginal
dryness, depression, irritability, headaches and sleep disorders, cognitive impairment may occur more
frequently in this period. 2

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These symptoms may exist at other times in their lives, so none can be considered specific to
perimenopause. This symptomatology can also vary from the perimenopausal period to the menopausal
and post-menopausal period. 7
The severity of these symptoms and the degree to which they interfere
with the activity and quality of life is variable in women. Climacteric symptomatology may be transient
(one or two years) but may last much longer in some women. 8
It is quite evident that a severe symptomatology with the "domino" effect (nocturnal sweats altering
sleep, tiredness impairing cognitive faculties, physical performance and therefore self-esteem and finally
sexuality disorders) can profoundly affect the personal, social and quality of life of some women. 9
The broad definition of quality of life includes areas such as physical health, psychological status, and
level of independence, social relationships, environmental characteristics and spiritual aspirations. 10
The
symptoms of menopause have a negative impact on the quality of life, especially in women on
menopausal transition. 6
Quality of life as a clinical measure is a complicated and controversial construction requiring scales to
be evaluated. Some are specific to the menopausal transition, others have a broader view of health,
including questions about physical, psychological function and are global scales of quality of life. 10
Studies showed that physical activity has positive effect on quality of life regardless of age, activity and
health status. 11,12
Physical activity is also associated with many health benefits, including reduced risk
of cardiovascular disease, metabolic syndrome, obesity, cancer, osteoporosis and depression. There is
evidence that regular physical activity can be an effective way to prevent or alleviate symptoms related
to menopause. 2
Researchers are focused on eating disorders among women aged between 40 and 65 years.13, 14,15
Indeed, around the average age of perimenopause an increase in eating disorders and related symptoms
are also observed in women.14,15
The eating disorder in women aged 40 to 60 years was found
significantly higher in perimenopausal women than in premenopausal women. 16
There is lack of studies on the relationship between menopause transition and the quality of life and
food behavior in Algerian women. The aim of this study was to find out the perimenopausal symptoms,
quality of life and eating behavior in west Algerian women.
II. METHODOLOGY
A prospective cross sectional study was carried out between February 22 and April 30, 2016 in 80 (48 ±
2 years) perimenopausal women, recruited at the Public Proximity Health Center, Misserghine, Oran.
The aim of this study was explained to all subjects and the investigation was carried out with their
consent.
For this purpose, a questionnaire was developed to collect all the information needed to assess socio-
economic status, quality of life in the form of various clinical symptoms, feeding behavior and daily
energy expenditure in various meals. Information of the subjects were recorded on a pre designed and
pre-tested performa. To correct and validate all questionnaires, a pre-survey was conducted in 10
perimenopausal women to check errors, rehearsals and poorly formulated questions.
The clinical record was used to collect all anthropometric characteristics of women such as; age, height,
weight, hip circumference, waist circumference and blood pressure. For socio-economic assessment,
educational, occupational, family responsibilities etc. were asked.

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Food behavior and their feeding habits were also assessed such as importance of breakfast,
consumption of meals outside the home, consumption of meals and food preference. To estimate food
consumption a 24-h "Recall and Record" method was used.
Quality life was assessed as per various symptoms like hot flushes, night sweats, depressed mood, sleep
disorders, sexual difficulties, cognitive disorders, vaginal dryness, urinary incontinence, joint pain etc.
Quality life was considered as excellent, good, acceptable and poor when women had equals to or less
than five symptoms, 6-10 symptoms, 11-15 symptoms and more than 15 symptoms respectively.
Statistical Method: Data thus collected were entered in MS Excel worksheet 2007 as master chart.
These data were tabulated and analyzed as per objectives. Socioeconomic levels, clinical symptom
frequencies, quality of life and eating behavior were calculated by the frequency. Quantitative data like
age, menstrual cycle etc were assessed as mean and standard deviation.
III. RESULTS
Out of these 80 women, 62 (77.5%) were married, 5 were unmarried, 6 were divorced and 7 were
widowed. It was also observed that 71.25% were responsible for their family and 55% were having
family size of more than 4 persons. Majority of women were lower secondary level educated and
unemployed. (Table 1).
Table 1
Profile of Study Population
S. No. Variables Number %
1 Marital Status
Married 62 77.5
Unmarried 5 6.25
Divorced 6 7.5
Widowed 7 8.75
2 Family responsibility
Yes 57 71.25
No 23 28.75
3 Number of Family Members
≤ 4 people 36 45
> 4 people 44 55
4 Level of Education
Illiterate 9 11.25
Primary 16 20
Lower secondary 20 25
Secondary 18 22.5
University 17 21.25
5 Employment status
Employee 29 36.25
Unemployed 51 63.75
Mean age of these women was found 48±2 years, mean weight was 74±11 Kg, mean body mass index
(BMI) found 29±4 kg/m2 and mean waist size/ hip circumference ratio was found 0.86±0.06. Mean
menstrual cycle was of 30±2 days and mean menstrual period was 5±1 days. (Table 2).

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Table 2
Quantitative Variables of Study Population
S. No. Quantitative Variables Mean SD
1 Age (Years) 48 2
2 Size (in Meter) 1.6 0.07
3 Weight (Kg) 74 11
4 BMI (Weight (kg) / Size² (m²)) 29 4
5 Waist Size/Hip Circumference 0.86 0.06
6 Menstrual Cycle (Days) 30 2
7 Menstrual Duration (Days) 5 1
Out of these women 66% have a regular menstrual cycle compared to 34% of women with an irregular
cycle. Results showed that 75% of women used contraception, 69% on oral contraceptives and 31% of
them used an intra-uterine device, while 25% of women do not used contraceptives. (Table 3)
questions.
Table 3
Variables related to Menstrual Cycle and Contraceptive use of Study Population
S. No. Variables Number %
1
Menstrual Cycle
Regular 62 66
Irregular 5 34
2
Contraceptive use
Yes 57 75
No 23 25
3
Type of Contraceptive in use
Oral 36 69
IUD/Implants 44 31
Quality of life of these women was assessed by having various symptoms (Table 4). It was observed
that 71% of women gained weight during menopausal transition. Other symptoms that affect women's
quality of life are like hot flushes in 81% of women, night sweats in 56%, palpitations in 70%, anxiety
in 79%, headaches in 75%, memory loss in 60% and sleep disturbed in 67% of women. Hair loss,
urinary incontinence, urinary tract infection and vaginal dryness were noted in 35% of women.
Table 4
Clinical Symptoms wise distribution of Study Population
Clinical Symptoms Present (%) Clinical Symptoms Present (%)
Weight gain 71 Breast pains 81
Hot flashes 54 Pain in the joints 84
Night sweating 56 Heavy legs 67
Daytime sweating 21 Leg cramps 5
Insomnia 58 Feeling tired 89
Disturbed sleep 67 Headaches, migraines 75
Anxiety, Sadness, Nervousness 79 Hair Loss 39
Abdominal bloating 70 Urinary incontinence 34
Palpitations 70 Repeated urinary infection 29
Memory gaps 60 Vaginal dryness 43
Majority of women eat 4 meals a day with the note that only 20% women used to have < 2 meals per
day and the breakfast of which was unavoidable in the almost all (96%). Majority (95%) of women eat
together with their families and only 5% of women who eat individually. In the period of menopausal

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transition, 61% of women reported changes in their eating behavior out of which 50% reported that
they consumed more food and 18% who consumed less food than before. The results showed that 83%
of women consumed a lot of sweets and fatty products in the form of snack, chocolates, sweets etc than
before this period. In addition, for the most part also preferred traditional dishes. The minority of
women nibbled and eating outside the house. (Figure 1)
Figure 1
When quality of life of these women was assessed as per the number of various symptoms mentioned in
table no.3, women having more than 16 symptoms i.e. poor quality of life was found in 16% and only
6% were having excellent quality of life (≤ 5 symptoms). Out of these women, 53% women having 11-
15 symptoms i.e. acceptable quality of life was found whereas 25% were having good quality of life (6-
10 symptoms). (Figure 2)
Figure 2
IV. DISCUSSION
The aim of this study was to assess the perimenopausal symptoms, quality of life and food behavior in
west Algerian women. Mean menstrual cycle was of 30±2 days and mean menstrual period was 5±1
4
20
96 95
11
61
18
83
Behavior and Eating Habits (in %)

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days. This variation may be more because of the critical threshold these become increasingly resistant
to gonadotropins19
The intensity of this phenomenon varies from one follicle to another. Indeed, while
some people no longer have the capacity to respond to FSH, others have retained a reserve of FSH
sensitivity sufficient to over-respond to the high levels of circulating FSH in these patients. Thus, the
length of the cycles will become variable depending on whether or not there is terminal follicular
maturation.9
Various symptoms found in this study showed that hot flushes, night sweats, palpitations, anxiety,
headaches, memory gaps, disturbed sleep were the most frequent in this period influencing quality of
life of the women. Rui-xia et al.20
also reported their observations well in resonance to this study. Hot
flushes were the most frequent symptom in perimenopausal women due to the sudden fall in estrogen
levels during periods of ovarian hypoactivity that disrupt certain neural systems involved in
temperature regulation.19
Night sweating, palpitations, difficulty falling asleep, disturbed sleep were
influenced by hot flushes. Also for anxiety, nervousness and sadness play a very important role in
altering well-being of women. Several studies indicate that the perimenopausal period was a period at a
higher risk of developing depressive syndrome than the confirmed menopausal period, especially when
there was a personal history of depression.9, 21
In this study psychological symptoms were found in 79% of women had a depressed mood problem,
which was quite less i.e. 41% in a study conducted by Manal et al (2015).22
This study showed that 81% of women suffered from hot flashes and night sweats. These observation
were in line of observations of Yakout et al23
who noted that 85% of women had a severe degree of hot
flushes and night sweats in their study among Saudi women.
This study also showed that 43% of women suffered from vaginal dryness and sexuality, while Yakout
et al 23
noted that more than half (62.5%) of women had sexual problems.
In this study, urinary incontinence or urinary tract infections were found in 34% which was almost
similar in a study conducted by Manal et al22
who reported that 36% of women had urinary problems.
But Yakout et al23
reported 67% had these problems.
The quality of life was assessed by the number of symptoms of perimenopause, the maximum score
was 20 symptoms and the latter were divided into 4 classes: excellent, good, accepted and poor. In the
present study, it was found that quality of life of these women was found of poor i.e. women having
more than 16 symptoms in 16% and only 6% were having excellent quality of life (≤ 5 symptoms). Out
of these women, 53% women having 11-15 symptoms i.e. acceptable quality of life was found whereas
25% were having good quality of life (6-10 symptoms). Manal et al 22
conducted a study in Qena City
(Egypt) in year 2015 and reported that 57% had an average quality of life, 6% had a good quality of
life, 35% a bad quality of life and 2% had an excellent quality of life.
V. CONCLUSION
It can be concluded that perimenopausal women suffer from several climates (hot flushes, night sweats,
palpitations, anxiety, nervousness, vaginal dryness, etc.), which may be the causes of several diseases
that occur after Menopause such as cardiovascular disease, osteoporosis and impairment of cognitive
function. For this, a healthy and balanced diet associated with regular physical activity was
recommended in this period.

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CONFLICT OF INTEREST
None declared till now.
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